I just recently finished reading an interesting essay on addictions by Dr Lloyd Sederer a psychiatrist at Columbia University. While I don’t agree with his recommendations, he does remind us of some seminal research from the 1970s that helps to explain the problem.

When I’ve written on this topic in the past, I always mention the large number of military personnel during the Viet Nam war who used substances. The US feared that many of them would continue when they returned to the US but most did not. Out of a war zone and back into leading a normal life, most had no need for substances. That was the topic of the research referred to as the “rat park”.

Rats who were caged were offered two types of drinks. One was pure water and the other was water laced with heroin or cocaine. The rats took the drug laced drink and continued to drink from it until they overdosed and died.

A second group of rats were put into social situations called rat parks. Here, they were able to play and cavort with their buddies, hold discussions and debates, have sex and generally enjoy themselves. While they occasionally tried the drug infused water, they mostly drank the pure water and did not overdose. The moral, of course, is that rats/people with meaningful activities in their lives tend to stay away from addicting behaviour.

Dr Sederer sees the solution to dealing with and treating those with addictions as having clinicians “focus on their families, their social communities, their sources of human contact and support”. Now Dr Sederer admits that he is not naive about human behaviour but he adds that “these questions open essential doors.”

The problem with his view is that it is over simplistic. He is correct that social situations are often precursors to addicting behaviour but those conditions cannot be alleviated entirely in the treating docs office. The problems are often societal and caused in large part by lack of meaningful work, low income, and the lack of societal safety nets. Work is disappearing to a large extent for those with minimal skills who used to be employed in factories, mines, and retail stores.

According to the Atlantic, The disappearance of manufacturing and the rise of opioid abuse has hit men in the Rust Belt hard. For many, the lack of work and low income with minimal social safety nets has lead to escape through drugs. And with increasing automation and artificial intelligence, more jobs will disappear in the future. We will be left with a society where the work force will continue to shrink resulting in even greater poverty.

Economists have suggested that there is a link between opioid addiction and unemployment. A more recent study by Vancouver Coastal Health demonstrated that The primary cause of the opioid crisis is a “complex interaction” of socioeconomic problems, such as unemployment and homelessness, combined with substance abuse and an increasingly dangerous black market supply.

Ten years ago, the Hamilton Spectator did an analysis of health conditions in that city and found that those who live in the poorest areas have the worst health and utilize health care more extensively. That paper just updated the study looking at opioid overdoses and deaths. What it found was that opioid addiction was far more prevalent in the poor sections of the city.

“This is about despair,” said Neil Johnston, a McMaster University researcher who was involved in the original study. He added

“It’s about despair, whether you’re hooked on something nasty and you feel you can’t get out or nobody cares whether you get out. One way or another it’s a terribly malignant force.”

The only viable solution, in my opinion, is a guaranteed annual income for those who are unemployable or whose incomes through work are very low. And this should be combined with making drugs available to those who are addicted. Portugal has demonstrated that the social and societal benefits of this policy are enormous.

Another group with addiction problems that I’ve just realized are those with serious mental illnesses. Again, a very complex issue but what I’m now noticing is that when the mental health system stabilizes people, they pay little or no attention to their other needs for meaningful activity or income. The system rarely provides any activities for them where they can be actively engaged,, possibly earn some extra money, make friends and have satisfying social activities. Drugs are a way of making themselves feel better when nothing else does.

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6 thoughts on “The Complexity of Addictions”

Interesting and thoughtful article . Clearly the complexity of this topic makes it difficult to tackle. But there is prevailing view out there that everyone into drugs is the victim of abuse of one sort or another.This is far too easy an answer . Some of the clean injection sites propagate the view that addicts have all been abused in childhood. In peddling such dogmatic views, they whip up havoc in the minds of many addicts, especially those whose primary problem is a serious persistent mental illness. Conspiracy theories abound Sad to say failure to stabilize a serious mental illness in the healthcare system is often at the root of the problem of illicit use of drugs At least it seems to me. Better inpatient medical care might make some inroads on this terrible dilemma.

Ask an addict why they use their drug of choice and they say, “It makes me feel good.” Drugs and mental illness is a “what comes first, the chicken or the egg?” quandary. So many times have I, as a psychiatric nurse of 17 years, seen clients stabilized in hospital with treatment and assistance for a disability pension and housing only to return psychotic a few months later. Community living brought them right back to where they were … medication non-compliance, use of illicit drugs for instant gratification, and mental instability. At least with regular visits from a mental health nurse we can intervene early on. As for meaningful family relationships for the addict — relatives tire of the chaos and the worry and eventually they must distance themselves from the addict. Many grandmothers are raising grand children because the parents are addicted and unfit. There is only so much help we can give to those who do not want to change. Regardless of professional treatments/ counselling/ financial and social supports, human behaviour remains persistently intractable unless the person is strongly motivated to do the difficult work involved. We need more study of cases of successful rehabilitation to see why some leave addiction with no treatment at all, why some succeed long term with supports, and why some never make it no matter who tries what.

I guess every workplace has its jargon. When I began nursing it was “patient”. Years later our bosses told us to use “client” because we were supposed to leave aside the medical model of care. Someone’s idea of progress.

i do believe we over subscribe to the childhood trauma theory. It is not quite so simple for the SMI of course, as life is traumatic for them in the best of settings. But there are other less obvious brain/mental shortcomings we can only guess at by such observables. . So with childhood trauma. Now my point. We, adults define childhood trauma. Temple Grandon wrote of a similar situation where slaughter house operators looked and saw what THEY thought was frightening balking cattle. Ms Grandon went through with the eyes of a cow and … different take. We as adults do not look with the eyes of a 6 week to 18 month old. but we know what is traumatic? perhaps not. And lets not forget predelivery life. Are mom’s stress hormones a childhood trauma? is poor eye to eye interaction related to trauma? and how do we know where they are caused?
is moms job a child trauma?
etc.

How true the last paragraph is.. people with drug addiction or an affinity for substance abuse has long been common amongst those with mental illness. This not not new as u suggest.. it compounds all mental health problems